Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WakeMed Pediatric Endocrinology
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 350-7584
(919) 231-0314
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0552
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
Enumeration date
05/13/2014
Last updated
09/12/2016
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